By MARSHA SHULER
Advocate Capitol News Bureau
The Jindal administration
supports a proposed partnership under which Our Lady of the Lake Regional
Medical Center
would become home to LSU’s Baton
Rouge teaching hospital, the state’s chief health
official said Tuesday.
State Department of Health and Hospitals Secretary Alan
Levine said the public-private partnership is the model the state should be pursuing
given the financial outlook for the LSU public hospital system.
“The dollars are just not going to be there for these
public hospitals as there has been in the past,” Levine told the state Senate
Finance Committee.
Beginning July 1, 2010, there will be $150 million
less for uninsured care, Levine said. The drop in federal money would hurt
LSU because of its reliance on those government health-care dollars, he said.
The Jindal administration
supports the closure of LSU’s Earl K. Long Medical Center,
called EKL, in north Baton Rouge and moving
its in-patient medical care and physician training programs to Our Lady of
the Lake Regional
Medical Center,
in south Baton Rouge,
Levine said.
“How much would the state be responsible for in the
public-private partnership?” asked Senate President Pro Tem Sharon Broome,
D-Baton Rouge, in whose district the Earl K. Long facility resides.
Levine replied that part of the current partnership
discussion involves the shift of available uninsured care dollars to the new
enterprise.
There will be construction costs associated with space for
medical care and teaching programs at the Lake,
Levine said.
“But that will be less expensive for the state” than
building a new hospital with an estimated $350 million to $500 million cost,
Levine said.
LSU has said about $120 million would be needed.
Levine said part of the discussion between LSU and the Lake has to do with financing of the construction work
“without tapping into the (state) debt limit.”
“The students will get a great learning experience. There
are services offered at OLOL that are not offered at EKL,” Levine said.
Broome asked whether Levine thought that the EKL and OLOL
had complimentary missions of medical education and treating the poor.
“I believe so,” replied Levine.
Broome said people have expressed concern about both
teaching possibilities and indigent care. She said she wants more discussion
with parties involved “to minimize any negative impact this merger may
bring.”
http://www.2theadvocate.com/news/46157457.html
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By Bill Barrow
Rep. Rick Nowlin doesn't hail
from New Orleans
or the surrounding area, but the Natchitoches Republican has dived into the
wrangling over the proposed state teaching hospital slated to be built in
lower Mid-City.
Nowlin is proposing legislation
that would block the state from buying or expropriating land intended for the
medical complex until its financing proposal is approved by the Legislature's
Joint Budget Committee.
House Bill 780 is scheduled for a hearing today in the
House Health & Welfare Committee, as the state continues preparations for
securing 70-plus acres for a state hospital and the planned adjacent U.S.
Department of Veterans Affairs medical complex.
The bill presents the latest challenge for state and
Louisiana State University System officials who have planned for a $1.2
billion, 424-bed facility for several years but have yet to secure financing.
The governance and business model also remain under scrutiny.
"LSU does a lot of good things with health care and
education, but this is bigger than that," Nowlin
said. "We shouldn't take people's homes and businesses until we at least
know we can finish the project and that we can operate it successfully."
The state Office of Facilities Planning and Control has
not taken a public position on the bill. Director Jerry Jones is expected to testify
about "the practical aspects of the bill," spokesman Michael DiResto said.
--- Cost implications ---
Dr. Fred Cerise, LSU vice president for health care, said
state officials are "concerned about the impact the bill would have on
the progress made in terms of land acquisition."
"Delays in early phases such as land acquisition will
push the entire project timeline back, with cost implications, and the city
can't afford to wait any longer" to replace the shuttered Charity
Hospital, Cerise said.
The bill would not stop preparatory work, including title
searches and negotiations with landowners.
Nowlin said he did not introduce
the measure on behalf of any particular interests, but he has the support of
preservationist groups that want the state to gut Charity and rebuild within
its shell.
The Foundation for Historical Louisiana, among other
organizations, argues that route would be faster and cheaper, while
preserving the lower Mid-City neighborhood, which features vacant, blighted
parcels and architecturally significant properties, some eligible for the
National Register of Historic Places.
"Don't take people's private property unless you have
a financial plan in place," foundation executive Sandra Stokes said.
She cited the never-completed final phase of the Ernest N. Morial
Convention Center as an
example of what can happen when government invokes its eminent domain
authority too early.
--- Federal hospital excluded ---
As written, Nowlin's proposal
would apply only to the state hospital's projected footprint, bound by Canal Street, South
Claiborne Avenue, Tulane Avenue
and Galvez Street.
It does not address the state's role in securing land across Galvez, up to South Rocheblave
Street, for the federal hospital.
That land now sits vacant. Opponents of the state's plans
have said the worst possible scenario is the veterans hospital proceeding as
planned with the state never building -- or long delaying -- its hospital,
leaving a gulf between the VA and the rest of the existing medical district.
The bill does not specifically define what would
constitute a "financing plan." Nowlin
said he intends to include both the initial capital budget and a viable
operating plan. To some extent, the distinction is moot,
because the construction budget depends on securing a minimum of $400 million
in bonds that investors almost certainly would not buy without a worthy business
plan.
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1243401658300600.xml&coll=1
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Shreveport Times | 05.27.09
LSU Health Sciences Center-Shreveport and Sci-Port: Louisiana's Science Center
will continue their Grey Matters lecture series with The Hungry Brain at 5:30
p.m. June 4 in Sci-Port's Space Dome Planetarium in
downtown Shreveport.
June 2 is the deadline to register for the lecture by Dr.
Kathryn Hamilton, who will discuss how food appearance and aroma affect
appetites. Chef John Strand, of Accents Personal Chef Service, will offer a
cooking demonstration in conjunction with the lecture. Space is limited. The
cost is $5 for nonmembers. Sci-Port members get in
free. The event includes a question-and-answer session, an informal reception
and heavy hors d'oeuvres.
http://www.shreveporttimes.com/article/20090527/NEWS01/905270322/1060
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Houma eye center to offer free services
Houma Today | 05.26.09
By Laura McKnight
HOUMA - The warm weather, friendly people and unbeatable
cuisine enticed Dr. Keith Kellum and his family to
plant roots in Houma nine years ago, a move that continues to make the
ophthalmologist feel fortunate.
"We love it here," said Kellum,
who grew up in Illinois.
"This community has been very good to me, to me and my family. We've
been blessed to be here."
The eye doctor now sees the troubled economy as an
opportunity to give back to the community that embraced him.
He and optometrist Lisa Mitchell, who works with Kellum at The Kellum Eye Center
in Houma,
plan to start offering a range of free services in June to local residents
who lack health insurance and the ability to pay for eye care.
"We've been thinking about what we can do to help out
in the community," Kellum said.
The Kellum Eye
Center plans to offer
free eye exams, eyeglasses, medications, surgeries and anything else the
patient may need that the center can provide, Kellum
said. The program will not include contact lenses or elective surgeries, such
as cosmetic procedures or laser vision-correction surgeries.
"If I'm doing a cosmetic surgery on one person I
can't do a functional surgery on another," he said.
Doctors often travel to foreign countries to offer free medical services, which is nice, Kellum
said, but needs exist nearby as well.
"We've got a lot of people here that need help,"
he said.
Kellum and Mitchell plan to see
about two patients per week, completely free of charge, as part of their new
outreach program.
Anyone who lacks health insurance and can not afford to
pay for eye care can sign up for the free services. Kellum
said he has no set number of free patients to be taken, but the numbers will
be limited to avoid overcrowding his practice.
"I could see 200 patients a week with no
insurance," Kellum said. "We can't help
everybody, but we can help some."
There are no income guidelines to sign on for free care.
"Most people tend to be very honorable and
honest," Kellum said. "If they need help,
we want to help them."
The eye clinic will treat patients receiving free services
as they would any other patients, Kellum said. For
example, free patients will not have to wait longer for appointments or other
services.
"Nobody will know the difference - except our billing
staff," Kellum said.
Along with free eye exams and eyeglasses, The Kellum Eye Center plans to connect patients in need with
free medications. Kellum said he could start
patients off with free samples and then staff can help them access free
medications through pharmaceutical companies. Most pharmaceutical companies
offer free medications to uninsured customers of certain income levels. The Kellum
Eye Center
already helps patients access these programs, so the staff and resources are
already set up to help new patients gain free medicine, Kellum
said.
The ophthalmologist plans to offer free surgery as needed,
including surgeries Kellum typically does in his
office, such as some eyelid surgeries and procedures to remove sties and
growths on the eye.
Some patients may
be referred to Leonard J. Chabert
Medical Center
in Houma for
more-involved surgeries, such as cataract or glaucoma surgeries, but Kellum said he could likely get those patients seen
faster at the charity hospital, especially if the need is urgent.
The only services a patient might have to pay for include
procedures at Chabert, which could be free or
charged on a sliding scale based on income, and laboratory testing, a service
not often needed, Kellum said.
The free eye care could help patients gain or keep jobs, Kellum said.
"A lot of people lose their ability to function if
they can't see," he said.
The eye care also could help some salvage their sight by
catching glaucoma early; a lot of people with glaucoma don't know they have
it, Kellum said.
Just receiving eyeglasses can make people into safer
drivers and more effective workers.
"Something as simple as that can make all the
difference," he said.
The nation's economic woes helped inspire the program, but
the center plans to continue offering free services as long as participants
need help in paying for eye care, no matter the country's economic situation,
Kellum said.
"We just want to give back to the community a little
more than we have been," he said.
The ophthalmologist, who attended medical school in Ohio, moved to south Louisiana
to complete his residency at Louisiana
State University
in New Orleans.
He worked for the Ochsner health system for a year
and then moved to Houma
to join Dr. Bryan Hemard's practice. Hemard retired a year and a half later, and Kellum opened his own practice in Houma. Kellum Eye Center
moved to 446 Corporate Drive
more than two years ago.
Kellum and his family quickly
adapted to the local climate.
"Growing up in Illinois,
I love the weather," he said.
Kellum said he and his family
also enjoy the locals, who he describes as warm, friendly and helpful.
"I have some of the best patients in the world,"
he said. "I get offers to go fishing at least twice a week."
And of course, there's the cuisine.
"Food in south Louisiana
can't be beat," Kellum said.
Other members of his family, including his wife's family,
plan to join the Kellums in Houma in coming months and years.
Kellum's daughter, an 8-year-old
spelling-bee whiz, was born here, "so we have roots here now," he
said.
For information or to sign up for free services, call Kellum
Eye Center
at 872-5577.
http://www.houmatoday.com/article/20090526/ARTICLES/905261003?Title=Houma-eye-center-to-offer-free-services
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Lake Charles clinic expands reach
By MARSHA SILLS
Advocate Acadiana bureau
LAFAYETTE
— Affordable health-care options are expanding in Acadiana.
Last summer, SWLA
Center for Health Services, a Lake Charles federally qualified health center opened a
satellite clinic in Lafayette.
And in July, it will open another satellite clinic in Crowley at 613 John F. Kennedy St.,
with primary care and dental services.
The centers act as a safety net for those living in
medically underserved urban and rural areas and are eligible for federal
funding to help offset the costs of caring for the uninsured.
Recently, SWLA received a federal infusion of $1.8 million
to defray the cost of services for the uninsured.
Of the center’s projected 9,000 patients, at least 40
percent are non-paying, according to Eligha
Guillory Jr., director of development and outreach for the center.
The clinics offer primary care and other health services
to both the insured and uninsured, who pay on a
sliding fee scale based on their income.
The need for affordable health services in southwest Louisiana prompted the Lake Charles agency to expand, Guillory
said. Its Lake Charles clinic is the only
federally qualified health center in the five parish area of Cameron,
Jefferson Davis, Calcasieu, Beauregard and
Allen.
“We try to increase access and decrease the barriers to
health care,” Guillory said.
SWLA’s satellite location in
Acadia Parish in Crowley will help bridge
services in southwest Louisiana.
The Crowley
clinic is opening with the assistance of a $1.3 million American Recovery and
Reinvestment Act grant administered by the U.S. Department of Health and
Human Services’ Health Resources and Services Administration.
The entire parish of Acadia is a designated health-care
professional shortage area, as is the northeast portion of Lafayette Parish
served by the Lafayette
clinic.
SWLA has been operating for 25 years and made the decision
to expand in Lafayette
with the help of a partnership with the Lafayette Housing Authority.
Its current Lafayette
clinic is temporarily located within a Housing Authority neighborhood at 716 Hellen St.
The Lafayette
clinic is housed in a temporary location — a modular building. A facility
will be built in a future Housing Authority neighborhood on Patterson Street
near Alice Boucher Elementary School.
It is expected to be complete sometime in 2010, Guillory said.
http://www.2theadvocate.com/news/46151322.html
[BACK TO TOP]
By JANET ADAMY
Conservative groups are stepping up the battle against
Democrats' proposed health-system overhaul with advertising campaigns
contending that the changes could result in long waits for surgery and
difficulty obtaining prescription drugs.
A conservative group will begin running a new ad campaign,
which equates Democrats' health care reform with long waits. The ad
highlights the direction Republicans will likely take the health care reform
debate, Janet Adamy explains.
Americans for Prosperity Foundation, a conservative
advocacy organization, on Wednesday plans to launch a $1.7 million
television-advertising campaign that negatively likens the U.S. health-care system envisioned by
lawmakers to Canada's
publicly administered system.
Another group, Conservatives for Patients' Rights, which
opposes a government-run health system, plans to begin airing 30-minute
segments on Sunday featuring unpaid commentary by patients and doctors from Canada and the United Kingdom detailing what
they describe as failings in their health-care systems. The U.K. system is run by the
government.
The conservative groups' campaigns seek to liken the
Democrats' proposed system to those in countries where the government has
more involvement in the health system. Many experts don't believe such
systems offer worse care than the current U.S. system, which is based
largely on private plans and coverage.
In the ad campaign by Americans for Prosperity Foundation,
a Canadian woman, who also was not paid, says: "As my brain tumor got
worse, my government health-care system told me I had to wait six months to
see a specialist."
Congress is considering some changes that could increase
the government's involvement in the health-care system. President Barack
Obama and some Democrats want to create a public health-insurance plan that
would help cover the uninsured and compete with private insurers, an idea
that has met strong resistance from Republicans.
But leading Democratic lawmakers drafting legislation to
expand health-care coverage and reduce its cost have said they wouldn't seek
to emulate either the Canadian or U.K. system. Senate Finance
Committee Chairman Max Baucus (D., Mont.) told reporters last week that he
was trying to craft "a uniquely American solution" where people who
like their health insurance can keep it.
Americans for Prosperity's ad is slated to run in eight
states that have lawmakers seen as influential in the health-care debate: Montana, Virginia, Arkansas, Louisiana, South Dakota, Indiana,
Alaska and Nebraska. The group is scheduling rallies
in Virginia
and elsewhere starting this weekend to muster opposition to proposed changes.
Conservatives for Patients' Rights began airing advertisements
in March, but it is intensifying its effort with a 30-minute spot that will
air on Sunday in the Washington
area. The spot is part of a planned $20 million ad campaign that will run as
lawmakers hash out a health-care overhaul.
http://online.wsj.com/article/SB124339409809957455.html
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By RITA BEAMISH and FRANK BASS
Facing Michigan's latest
budget cuts, Kent
County health director
Cathy Raevsky sized up the local impact: no more
nursing visits to new moms, fewer restaurant inspections and reduced
communicable disease control. There was a familiarity to the cuts. "I've
been doing it for seven years," she said ruefully.
Already down more than one quarter of her staff, Raevsky managed the recent, limited swine flu outbreak by
stretching her team. But a major, sustained outbreak would overwhelm the
county, she said, echoing the concern of many local health departments that
are the community bulwarks against disease and health emergencies in the United States.
Swine flu fell short of a full-blown international crisis,
but revealed the precarious state of local health departments struggling with
cutbacks as well as increased demand from people who have lost jobs and
medical insurance.
Stung by the lean economy, 13 states and U.S. territories had smaller
health budgets in 2008 than in 2007, and eight more made midyear cuts, according
to a survey by an advocacy group, the Association of State and Territorial
Health Officials. With local budgets also in trouble, and new cutbacks
anticipated this summer, many health officials fear a serious outbreak.
"We won't be able to do it," Raevsky
said. She said getting vaccine to everyone would require shutting down all
other services, plus pulling workers from other departments.
A review by the U.S. Health and Human Services Department
in January noted great strides in preparedness but said many shortfalls
remain. They include the ability to maintain public health functions such as
food safety and daily needs during a pandemic, and the capacity to meet
surges in health care demand and to strategically close schools.
State capabilities vary. But among some local departments
that rely on a combination of federal, state and local revenues, an
Associated Press review found troubling signs:
_Twenty-nine public health workers in Sacramento County, Calif.,
learned just before being called to work on swine flu that they probably will
lose their jobs this summer. Senior nurse Carol Tucker, contacting potential
flu victims, thought about future epidemics.
"Who will be around to do these things?" she
said.
_Nationwide, officials have reported more than more than
6,700 swine flu cases, and 12 deaths.
"We have good plans and we're exercising them,"
said Matthew A. Stefanak, health commissioner of Mahoning County, Ohio,
whose work force dropped 20 percent in two years. "But for the nuts and
bolts of an outbreak — contact investigations, probable cases of H1N1 flu —
we don't have the manpower, the trained disease investigators the public
health nurses who would do it. That's where we're weakest right now."
_Federal investment in local emergency planning since the
attacks of Sept.
11, 2001, has paid off in a smooth response to the limited swine
flu outbreak. But the money has dwindled.
Last year at least 10,000 local and state health
department jobs were lost to attrition and layoffs, including at laboratories
that identify disease strains, according to surveys by the state and
territorial group and the National Association of County and City Health
Officials.
An annual flu-shot clinic no longer comes to town hall in Berlin Center, Ohio.
"The real danger is how many just won't get shots," said Ivan
Hoyle, 78.
_People calling for routine immunizations now reach a
recording saying the Worcester,
Mass., clinic is closed. With
just two of its six public health nurses surviving layoffs, the city is
re-evaluating its responsibilities and says it can meet emergencies by
working with the University
of Massachusetts and
local hospitals.
Ann Cappabianca, one of the
remaining nurses, scrambles to track communicable disease and tuberculosis
cases. "We just can't get it all done. You try to focus on the most
important thing at the moment," she said.
Worst is having to make cuts
without "enough ability to assess the needs of my community," said
Bob England, the health director of Arizona's
sprawling Maricopa
County, which closed
its family planning clinic.
Public health departments will get some help from this
year's stimulus spending of $1 billion for prevention and wellness efforts.
But it will take years to bring local health agencies to
the point where they can fight a sustained, widespread pandemic, said Richard
Hamburg, a lobbyist at the nonprofit Trust for America's Health, an advocacy
group supported by private and government grants.
A report from the group in December found emergency
planning gaps in areas such as rapid disease detection, food safety and
"surge capacity" to quickly scale up equipment, staff and supplies
to meet a major outbreak.
Dan Sosin, head of emergency response
at the Centers for Disease Control and Preparedness, praised the federal
swine flu response, but acknowledged that public health officials face
"capacity issues in terms of ongoing resources and funding."
"We could spend more money," he said. "We could
use more than we have."
The CDC's acting director, Richard Besser,
told Congress last month the government is concerned about states being too
short-staffed to conduct required emergency exercises.
The main fund for local health emergency planning after
the Sept. 11 attacks, the federal Public Health Emergency Preparedness
program, has dropped nearly one-third since a 2006 peak of almost $1 billion,
according to CDC figures. The money had included a special three-year
congressional allocation for pandemic flu preparation that ran out last year.
President Barack Obama now is asking Congress for $1.5
billion to fight swine flu.
A second fund to help local agencies plan for public
health emergencies, the Hospital Preparedness Program, has fallen nearly a
quarter from $457 million in the 2006 budget year.
Decreases in the Public Health Emergency Preparedness
program were most significant in Iowa, Mississippi, Colorado,
Missouri, Michigan,
Ohio, Pennsylvania
and Louisiana.
After a pair of killer hurricanes hit Louisiana
in 2005, Washington
sent nearly $15 million in 2006 health emergency help. This year, it's down
to $9.8 million.
Even New York
City, site of one of the Sept. 11 attacks, saw its
Public Health Emergency Preparedness program funds fall to $20.6 million this
year from $28.7 million during the 2006 budget year.
In Orange County,
Fla., people were diverted from
other duties for swine flu needs in a health department increasingly burdened
with a range of demands as people lose jobs, said health director Kevin Sherin.
Sherin, president of the
advocacy group American Association of Public Health Physicians, questioned
longer-term capabilities for lab and field work in his state and elsewhere.
"In the event of a real emergency, these systems have
capacity problems," he said.
Georges Benjamin, executive director of the American
Public Health Association, a nonprofit lobbying group, said that after the
federal emergency buildup, "We didn't complete the job and we didn't
make the system sustainable. Our ability to manage more than one thing, or
scale up fast is really worrisome."
http://www.google.com/hostednews/ap/article/ALeqM5iXxwlXbCCk1pvBiGkFlY0e2eyeAAD98E3T0G0
[BACK TO TOP]
The New York Times | 05.26.09
By ROBERT PEAR
WASHINGTON — President Obama’s campaign to cut health
costs by $2 trillion over the next decade, announced with fanfare two weeks
ago, may have hit another snag: the nation’s antitrust laws.
Antitrust lawyers say doctors, hospitals, insurance
companies and drug makers will be running huge legal risks if they get
together and agree on a strategy to hold down prices and reduce the growth of
health spending.
Robert F. Leibenluft, a former
official at the Federal Trade Commission, said, “Any agreement among
competitors with regard to prices or price increases — even if they set a
maximum — would raise legal concerns.”
Already, some leaders of the health care industry who
appeared at the White House on May 11 say the president may have overstated
their cost-control commitment. Three days after the gathering, hospital
executives said that they had agreed to help save $2 trillion by gradually
slowing the growth of health spending, but that they did not commit to
cutting the growth rate by 1.5 percentage points each year for 10 years.
White House officials say even the more limited commitment
is significant. Under current law, federal officials predict that health
spending will grow an average of 6.2 percent a year, to $4.4 trillion in
2018.
Mr. Obama is asking the industry for detailed proposals to
control costs. But so far the administration has not offered the industry any
relief from antitrust laws and has, in fact, vowed to step up enforcement.
As a presidential candidate, Mr. Obama said consumers had
suffered because of “lax enforcement” of antitrust laws in many health
insurance markets.
In 1993, when President Bill Clinton made the last major
effort to overhaul the health care system, the lobby for the drug industry,
then known as the Pharmaceutical Manufacturers Association, devised a
voluntary cost-control plan. Under it, each drug company offered to limit the
annual increase in the average price of its prescription drug products to the
increase in the Consumer Price Index.
The Justice Department rejected the proposal, saying it
would violate antitrust laws. In blocking the proposal, the department said
the Supreme Court had made clear that agreements setting maximum prices were
just as illegal as agreements that set minimum ones.
“Such maximum price-fixing agreements create the risk that
the maximum prices will become minimum or uniform
prices,” the department said in a business review letter signed Oct. 1, 1993,
by Anne K. Bingaman, then the assistant attorney general in charge of the
antitrust division.
In 1978, hospitals also asked the Justice Department for
an assurance they would not be charged with antitrust violations when they
undertook a “voluntary effort” to curb costs as an alternative to legislation
proposed by President Jimmy Carter. The department would not provide such an
assurance.
Many savings now envisioned by the health care industry
would require much closer cooperation by independent doctors and hospitals,
taking them into a gray area of the law where federal agencies have not
provided clear guidance.
In a recent letter to the Senate Finance Committee, the
American Hospital Association said uncertainty about enforcement of the
antitrust laws “makes it difficult for a hospital and doctors to collaborate
to improve care” and lower costs.
Doctors often want to collaborate and share information
about prices without sharing financial risk or fully merging their office
practices. The American Medical Association has asked Congress to revise
antitrust laws so doctors can collectively negotiate with insurers over fees
and other issues.
The Federal Trade Commission has repeatedly challenged
such collective action as illegal price-fixing, even though doctors say they
are at a severe disadvantage in trying to negotiate with giant insurance
companies.
A new study by an economist at Northwestern University,
Leemore S. Dafny, finds
that a growing number of geographic markets are dominated by a handful of
insurance companies, and that the decline in competition may contribute to
higher prices.
Among the groups that say they have joined together to
rein in health costs, besides the hospital and medical associations, are America’s
Health Insurance Plans and the Pharmaceutical Research and Manufacturers of
America.
Jamie Court,
the president of Consumer Watchdog, an advocacy group, said he was wary of
such joint efforts.
“When companies that control the health
care system get together to change it, there is a serious risk that
they are doing it to stifle competition at the expense of consumers,” Mr. Court said.
The Federal Trade Commission says that while cooperation
among health care providers can benefit consumers, it can also increase the
bargaining power of hospitals and doctors, making it easier for them to set
prices and eliminate competition.
http://www.nytimes.com/2009/05/27/health/policy/27health.html?_r=1&ref=health
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The New York Times | 05.26.09
By DENISE GRADY
The choice of Judge Sonia Sotomayor
for the Supreme Court has put a spotlight on Type 1 diabetes, the disease she
has lived with for more than 45 years.
The illness, which causes abnormally high levels of blood
sugar, should not interfere with Judge Sotomayor’s
ability to do her job, according to the American Diabetes Association.
The White House made the same point Tuesday, saying Judge Sotomayor’s diabetes had been under control for decades
through insulin injections and careful monitoring.
Still, Dr. R. Paul Robertson, an endocrinologist at the
University of Washington and the diabetes association’s president for
medicine and science, said that given the seriousness of the disease and of
the proposed job, the public had a right to know how the judge was
controlling her diabetes — and how well.
The severity of the disease and the difficulty in
controlling it vary greatly by individual, and so does the tendency to
develop complications, Dr. Robertson said.
Type 1 diabetes is sometimes called juvenile diabetes,
because it often starts in childhood, as Judge Sotomayor’s
did when she was 8 years old; it affects a million Americans. It can lead to
heart disease, kidney failure, nerve damage, infections, amputations and
blindness. On average, the disease shortens a person’s lifespan by 7 to 10
years, according to the Juvenile Diabetes Research Foundation.
Dr. Robertson said the best way to minimize complications
was to keep blood sugar under control, which patients could do by testing
their blood and injecting insulin several times a day. Some patients wear
pumps that inject insulin through implanted tubing.
But tight control is no guarantee. For reasons no one
understands, some people who follow all the rules suffer complications
anyway, while others who are more lax somehow get away with it, Dr. Robertson
said.
http://www.nytimes.com/2009/05/27/health/27diabetes.html?ref=health
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The New York Times | 05.26.09
By RONI CARYN RABIN
A growing number of hospital patients are routinely given
drugs to prevent acid reflux. But a new study has found that patients who
take these so-called proton pump inhibitors are at higher risk for pneumonia
than those who do not.
The drugs — including Nexium, Prilosec and Prevacid — are
often recommended for intensive-care patients to prevent stress ulcers, and
in recent years they have been given to many other hospital patients, in
large part because they are widely perceived to be safe. Experts estimate
that 40 percent to 70 percent of inpatients now receive acid-suppressive
drugs during a hospital stay, with about half receiving them for the first
time.
“I noticed that there were a lot of patients being placed
on these for prophylactic purposes, and I thought that was curious because
they are not currently recommended for patients who aren’t at high risk for
stress ulcers,” said the study’s lead author, Dr. Shoshana
J. Herzig, chief medical resident at Beth Israel
Deaconess Medical Center in Boston, explaining why she was interested in the subject.
Dr. Herzig said that proton pump
inhibitors, which suppress acid in the stomach, might promote the growth of
different types of bacteria in the upper gastrointestinal and respiratory
tract, and that those bacteria might be the culprits in the pneumonias.
Another explanation, she suggested, may be that acid stimulates coughing, and
coughing less may promote pneumonia.
The study, published in The Journal of the American
Medical Association this week, analyzed 63,878 admissions to Beth Israel
Deaconess from Jan.
1, 2004, to Dec. 31, 2007. All of the records belonged to adults
hospitalized for three days or more, who had not been in intensive care.
Acid-suppressive drugs were ordered for just over half of the patients.
Among patients who received the drugs, 4.9 percent
developed pneumonia in the hospital — more than double the 2 percent who had
not been given the drugs. After adjusting to account for the fact that
recipients of the drugs may have been sicker to begin with, the researchers
determined that patients treated with acid-reflux drugs faced a 30 percent
increase in pneumonia risk over patients who were not.
The increase in pneumonia was not seen among patients who
took a type of acid-reflux drug known as histamine-2 receptor antagonists,
sold under names like Pepcid and Zantac.
A spokesman for AstraZeneca, which makes Nexium, also known as “the purple pill,” said the study
had limitations and could not definitively show that the drug caused excess
pneumonia.
Earlier reports have linked proton pump inhibitors to
other complications, including community-acquired pneumonia, hip fractures
and diarrhea associated with Clostridium difficile.
Although the drugs are used to prevent stress ulcers, “a
lot of people don’t need to be on them in the first place, and they’re sent
home on them and stay on them,” said Dr. Joel J. Heidelbaugh
of the University
of Michigan. He added
that such inappropriate use of the drugs drove up the costs of health care.
http://www.nytimes.com/2009/05/27/health/27drugs.html?ref=health
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